Surgical treatment of active and sequelar forms of pulmonary tuberculosis

Background. The incidence of tuberculosis has risen since 1990, and in some countries, the resistant forms are becoming more and more frequent. Surgic al treatment is once again needed to manage these problems. The purpose of this study was to analyze the indications and results of resection, which w e performed for pulmonary tuberculosis. Methods. From 1980 to 1997, 477 patients were operated on for thoracic or i ntrathoracic tuberculosis in Laennec Hospital, Paris (259 suffered lung dis eases). There were 165 women and 94 men, aged 25 to 86 years (mean 46 years ), from Europe (n = 148), North Africa (n = 65), Subsaharian Africa (n = 34 ), Asia (n = 7), and the West Indies (n = 5). This population was reviewed concerning the lung tuberculosis (sequelae or active lesions), the indicati ons of lung resection, the type of resections performed, and the results at 1, 6, and 12 months. Results. Active lesions were present in 97 eases and sequelae in 162. Surge ry was performed for a therapeutic purpose in 104 patients with sequelae, a nd in 10 patients with active tuberculosis (pneumonectomy, n = 19; pleuropn eumonectomy, n = 19; lobectomy, n = 54; and segmentectomy, n = 22), Surgery was performed for a diagnostic purpose in 54 patients with sequelae, and i n 87 patients with active lesions (lobectomy, n = 32; segmentectomy, n = 19 ; wedge resection, n = 94, of which 11 performed by video-assisted thoracos copy since 1991). One patient died after pleuropneumonectomy. We observed 2 5 complications: empyema, n = 7;hemothorax, n = 2; prolonged air leaks, n = 14; and pneumopathy, n 2. All patients with active lesions subsequently we re given antitubercular drugs. Follow-up was 100% at 1 month, 57% (n = 92) and 77% (n = 75) at 6 months for patients with sequelae and for patients wi th active lesions, respectively. All were asymptomatic with a normal chest roentgenogram. The number of operations for active lesions is increasing ov er the years, while it is decreasing for sequelar lesions. Conclusions. In our department, surgery is being performed more frequently to make a diagnosis in cases of active tuberculosis, and to treat complicat ed lesions in case of sequelae. Lung resection for active tuberculosis evol ving under treatment or for drug resistance was rare. However, our study co nfirms the good results commonly obtained by surgery and supports the idea that surgery may help eradicate tuberculosis when social and economic circu mstances render its medical management difficult or hazardous. (C) 2001 by The Society of Thoracic Surgeons.